Recurrent Dislocation Research Articles

The efficacy of medial patellofemoral ligament reconstruction combined with distal femoral varus osteotomy inrecurrent patellar dislocation and genu valgum.

Medial patellofemoral ligament (MPFL) reconstruction is a widely recognized treatment for recurrent patellar dislocation. However, limited research addresses the outcomes of combining MPFL reconstruction with distal femoral varus osteotomy, particularly in patients with genu valgum. This study aims to evaluate the clinical outcomes of this combined surgical approach in individuals experiencing recurrent patellar dislocation associated with genu valgum. A systematic review followed PRISMA guidelines by searching the PubMed, Scopus, and Cochrane Library databases through July 1, 2024. Studies included patients whose MPFL reconstruction was combined with distal femoral varus osteotomy to treat recurrent patellar dislocation and genu valgum. A meta-analysis was performed to evaluate pain, clinical and functional outcomes, with data reported as mean difference (MD) and 95% confidence interval (CI). A total of three studies with 58 knees were included. Most of the patients were female 62.5%, with a mean patient age of 20.5years and a mean follow-up of 26.4months. The mean preoperative mechanical leg axis was 6.8° of valgus. After MPFL reconstruction with distal femoral varus osteotomy significant improvements were found in the Kujala score (MD, 33.64 [95% CI 31.3-35.99]), Lysholm score (MD, 34.89 [95% CI 23.27-46.51]), visual analog scale score for pain (MD, -3.99 [95% CI -5.66 to -2.31]), and Tegner Activity Score (MD, 1.96 [95% CI 1.63-2.29]). No subluxation or redislocation occurred in any study during the follow-up period, and all reported radiological correction of genu valgum. Combined medial patellofemoral ligament reconstruction and distal femoral varus osteotomy in patients with recurrent patellar dislocation and genu valgum lead to significant improvements in clinical outcomes, such as pain relief and functional scores, as well as effective radiological correction of valgus deformity. However, further high-quality studies are needed to confirm these findings and establish stronger evidence for this combined approach. Systematic review and meta-analysis, level IV.

Treatment of recurrent shoulder dislocation by arthroscopic subscapularis augmentation using the long head of the Biceps tendon

Treatment of recurrent shoulder dislocation by arthroscopic subscapularis augmentation using the long head of the Biceps tendon

Management of Habitual Patellar Dislocation in Pediatrics

Habitual patellar dislocation occurs when the knee is bent and returns to its usual position when straightened. Habitual patella dislocation is 13.5 per 100,000 in children under 13 and 147.7 per 100,000 in children 14–18. This review aims to present a comprehensive and complete literature on the management of habitual dislocation of the patella so that appropriate therapy can be obtained. A complete literature review was used in this investigation. Source search databases are PubMed, Science Direct, and Google Scholar. The literature study shows that habitual patellar dislocation in children is infrequent. Stability requires bone and connective tissue that match the patellofemoral joint. Patella alta, torsional, angular, trochlear dysplasia, muscular anomalies, ligamentous laxity, or ligament damage can produce lateral patellar habitual instability. The quadriceps muscle drags laterally to the limb's mechanical axis. Clinical children with recurrent patellar dislocation may experience a sudden dislocation that "disappeared somewhere." If this condition returns, patients frequently develop unusual knee edema and inflammation. MRI, CT, and plain radiography can diagnose this condition. A CT scan can detect trochlear dysplasia. Joint effusion, osteochondral lesions, medial retinaculum tears, and medial patella and lateral femoral condyle cartilaginous discolorations can be seen by MRI. Conservative or surgical treatment of habitual patellar dislocation depends on the deformity and its effects.

Opioid Consumption Following Isolated and Recurrent Shoulder Dislocation and Reduction.

Recurrent shoulder dislocations often lead to multiple encounters for reduction and eventual surgical stabilization, both of which involve exposure to opioids and potentially increase the risk of chronic opioid exposure. The purpose of our study was to characterize shoulder instability and compare pre- and post-reduction opioid usage in singular dislocators (SD) and recurrent dislocators (RD). This retrospective study was performed at a single academic institution using a prospective database. Patients were included if they were 1) age 18 or older and 2) sustained a shoulder dislocation evaluated within our institution. Electronic medical records were reviewed for patient demographics, emergency department management, and opioid exposure (number and mean morphine equivalent [MME] of opioid prescriptions) both pre- and post-reduction. Cohorts were compared using Wilcoxon rank sum tests for continuous variables and chi-squared or Fischer's exact tests for categorical variables with statistical significance set at p<0.05. 222 patients were included with mean follow-up 4.4 months (range: 0-70.1 months). 53 (23.8%) patients sustained recurrent dislocations. RDs were significantly younger (median age 26.7 years, IQR: 21.6-44.9) than SDs (55.3 years, IQR: 32.8-70.4; p<0.001) and more likely to have sustained a prior shoulder fracture (n=11 [21.2%] vs. n=3 [1.8%], p<0.001). There were no differences in sex, laterality, or follow-up duration. 18 (34.0%) RDs and 18 (10.7%) SDs underwent surgery including shoulder stabilization procedures, rotator cuff repairs, and fracture fixation (p<0.001). RDs used significantly more opioids at the first follow-up in both the prescribed number of opioids (mean 0.23± 0.5 prescriptions vs. 0.10 ± 0.3, p=0.038) and MME (mean 38.3 ± 96.2 MME vs. 10.7 ± 66.4 MME, p=0.013). This difference is not appreciated from the 30-day postoperative visit onwards. Emergency Room opioid MME prescription and consumption was similar between cohorts. Patients who sustain recurrent shoulder dislocations exhibit a higher likelihood of consuming significantly greater amounts of opioids following shoulder reduction and ultimately undergoing surgical intervention. The proportion of opioid tolerance and pre-reduction total MME up to 90-days prior to reduction in the recurrent dislocator cohort trended towards significance, but there were no differences observed between rates of opioid usage during ED encounters or at the 30-, 60-, and 90-day timepoints. Patients with chronic shoulder instability should be counseled regarding the increased risk of opioid prescription patterns in the immediate post-reduction period however this risk may decrease over time.

Robot-assisted medial patellofemoral ligament reconstruction in the treatment of recurrent patellar dislocation can improve tunnel accuracy but yields similar outcome compared with traditional technique.

To review patients with recurrent patellar dislocation surgically treated with robot-assisted medial patellofemoral ligament (MPFL) reconstruction compared with patients who underwent surgery using the traditional freehand technique. A retrospective cohort study was performed to identify patients who underwent MPFL reconstruction from January 2020 to December 2023 in our hospital. The inclusion criteria were: patients aged from 15 to 50 years; patellar dislocation occurred two or more times; a Merchant view or computed tomography (CT) scan indicating patellofemoral joint malalignment, external patellar inclination, or lateral patellar dislocation; underwent MPFL reconstruction via robot-assisted or traditional freehand technique; complete medical records and imaging data before and after surgery; a minimum of 1 year of postoperative follow-up. The operation duration, intraoperative fluoroscopy number, hospitalization length, Kujala score, and Lysholm score were recorded. In addition, the Bisect offset index (BOI) and the distance between the femoral tunnel and Schöttle point (DTS) were measured based on the preoperative and postoperative CT data of each patient in the two groups. The mean follow-up times of the two groups were 27 ± 8 months and 31 ± 9 months, respectively (p = 0.05). Neither group of patients experienced patellar re-dislocation. The median number of the fluoroscopy in the robot-assisted group was 4.5 times lower than in the freehand group (9 times, p < 0.001). The distance between the femoral tunnel and Schöttle point (DTS) in the robot-assisted group was 2.57 ± 0.97 mm, which was significantly shorter than the freehand group (5.58 ± 2.92 mm, p < 0.001). The bisect offset index (BOI) changed to 0.71 postoperatively compared with preoperative 1.07 (p < 0.001) in the robot-assisted group; similar changes were observed in the freehand group (0.69 vs. 1.00, p < 0.001). The Kujala score and Lysholm score were both significantly improved postoperatively in the two groups. Specifically, the postoperative Kujala score and Lysholm score in the robot-assisted group (89 and 89) were higher than the freehand group (85 and 84, p = 0.03 and p = 0.02). Moreover, the results also showed higher postoperative functional scores in the robot-assisted group when the cases were divided into 1-year and 2-year groups. However, the cohort-specific minimal clinically important difference (MCID) analysis revealed no significant difference in the patient-reported outcomes (PROs) (Kujala score and Lysholm score) between the two groups. Robot-assisted MPFL reconstruction for recurrent patellar dislocation achieved higher accuracy of femoral tunnel and lower radiation exposure compared to freehand technique. Nonetheless, the PROs showed no difference in rates of achieving MCID between the two groups. Level Ⅲ, retrospective case-control study.

Effectiveness of modified single patellar tunnel medial patella femoral ligament reconstruction for recurrent patellar dislocation

To investigate the effectiveness of modified single patellar tunnel medial patella femoral ligament (MPFL) reconstruction in the treatment of recurrent patellar dislocation. Between January 2023 and June 2023, a total of 61 patients with recurrent patellar dislocation who underwent MPFL reconstruction with autologous semitendinosus were enrolled and divided into 2 groups using random number table method. In the patellar anchor group, 31 patients were treated with MPFL reconstruction with double medial patellar anchors, and 30 patients in the patellar tunnel group were treated with MPFL reconstruction with single patellar tunnel. The femoral ends of both groups were fixed with absorbable compression screws. There was no significant difference in baseline data such as gender, age, side, tibial tubercle-trochlear groove (TT-TG), Q angle, Caton-Deschamps index, number of dislocation, and preoperative Kujala score, preoperative patellar inclination angle ( P>0.05). Patellar tunnel, patellar anchor position, patellar reduction, and the patellar inclination angle were measured by CT scan after operation. Kujala score was used to evaluate the function of knee joint before operation, at 2 weeks and 1, 3, 6, 12 months after operation. Incision aesthetic satisfaction score was performed at 3 months after operation. The signal-to-noise quotient (SNQ) of the transplanted tendon was measured by knee MRI at 12 months after operation to compare the maturity of the graft between the two groups. There was no significant difference in operation time and intraoperative blood loss between the two groups ( P>0.05). Knee CT reexamination showed that the patellar tunnel and the patellar anchor position were consistent with the intraoperative fluoroscopy. There was no significant difference in the difference of the patellar inclination angle between the two groups before and after operation ( P>0.05). All patients were followed up 12-14 months (mean, 12.8 months). There was 1 case of patellar anchor suture rejection in patellar anchor group, and the wound healed after debridement and dressing change. During the follow-up, there was no complication such as recurrence of patellar dislocation, infection and postoperative stiffness. The Kujala scores of the two groups significantly improved at each time point after 1 month of operation when compared with those before operation ( P<0.05), and the Kujala scores of the two groups returned to normal levels at 3 months after operation. The Kujala score in the patellar tunnel group was significantly higher than that in the patellar anchor group in the very early stage (2 weeks) ( P<0.05), and there was no significant difference between the two groups at other time points ( P>0.05). Patients in the patellar tunnel group were significantly better than those in the patellar anchor group in the score of incision aesthetic satisfaction at 3 months after operation and the SNQ at 12 months after operation ( P<0.05). Modified single patellar tunnel MPFL reconstruction was used to treat patients with recurrent patellar dislocation without pathological TT-TG. The slide-fixation structure formed by single patellar tunnel positioning provides a variable degree of freedom for the reconstructed MPFL, which shows good effectiveness in the very early stage of the rehabilitation process.

Efficacy of selected treatment protocol in the management of recurrent dislocation of shoulder joint- A Pre-Post study design

Background: Recurrent shoulder dislocation is a prevalent condition in orthopedic practice, particularly affecting young adults and significantly disrupting their daily activities. Treatment approaches, particularly in the context of Sandhimoksha, emphasize enhancing joint stability and strengthening the surrounding muscles to prevent further dislocations and improve overall function. Aim-To clinically prove the effect of selected treatment protocol in the management of recurrent dislocation of shoulder joint.Materials and methods: The study was a pre-post clinical trial involving 15 participants from a single group, selected based on specific inclusion and exclusion criteria. The participants diagnosed with recurrent dislocation of shoulder joint was subjected to selected treatment protocol which comprises of reduction and bandage with sling , snehapana followed by abhyanga with ushma sweda and virechana, ekanga dhara and nasyam, ajamamsa samyuktha ekanga shashtikapinda sweda and anuvasana vasti for a maximum period of 51 days. Along with above procedures, internal medications was also administered . Assessment was done on the day of admission, after each procedure and on the day of discharge .Follow up was done once in every month for 3 months after discharge. Results: Both subjective and objective parameters were statistically significant with P &lt;0.0001. The selected treatment protocol was found to be effective in the management of recurrent dislocation of shoulder joint Conclusion: The results demonstrated that the selected treatment protocol effectively reduced pain, minimized muscle wasting, and improved the range of motion in cases of recurrent shoulder joint dislocation

Comparison of Long-term Outcomes of Scleral-fixated IOL: Sutured vs. Suture-less Fixation

Purpose: This study compared the long-term outcomes and complications associated with sutured and suture-less scleral fixed intraocular lenses (SFIOLs), the two primary surgical techniques for scleral fixation of IOLs.Methods: A total of 90 patients were included in the study with 46 in the sutured group and 44 in the suture-less group. These patients underwent SFIOL between January 2019 and June 2023 due to IOL dislocation, aphakia, or crystalline lens dislocation. Collected data included age, gender, axial length, operative time, best corrected visual acuity (BCVA), intraocular pressure (IOP), refractive value, refractive error, ocular residual astigmatism, IOL dislocation, recurrent IOL dislocation, IOL tilt, and IOL iris capture. Changes from preoperative status to 1 year postoperatively were assessed.Results: No significant differences were found between the sutured and suture-less groups regarding preoperative BCVA, IOP, and refractive values. However, the suture-less group demonstrated significantly better BCVA at both 1 week and 1 month postoperatively compared to the sutured group (&lt;i&gt;p&lt;/i&gt; = 0.010, 0.015, respectively). The refractive error in the suture-less group was also significantly lower at 1 week postoperatively (&lt;i&gt;p&lt;/i&gt; = 0.020). Ocular residual astigmatism was consistently lower in the suture-less group across all postoperative intervals (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). While the suture-less group showed a shorter average surgical time, there was greater variability in operative duration (&lt;i&gt;p&lt;/i&gt; &lt; 0.001, 0.024, respectively). Additionally, a longer axial length was associated with an increased incidence of IOL iris capture (&lt;i&gt;p&lt;/i&gt; = 0.004).Conclusions: Suture-less SFIOL is associated with shorter operative times, although with greater variability. Patients in the suture-less group experienced faster BCVA improvement, reduced refractive error, and lower ocular residual astigmatism compared to those in the sutured group.

Patients with jumping sign exhibit rotational and bony structural abnormalities consistent with high-grade J-sign in recurrent patellar dislocation.

To propose a new sign of patellar maltracking in recurrent patellar dislocation (RPD) and compare the differences in lower limb rotational and bony structural abnormalities among the different signs. A retrospective study included 279 patients (mean age: 22 years; female: 81%) who underwent primary surgery for RPD over the past 4 years was performed. The patients were grouped based on the characteristics of patellar tracking: low-, moderate- and high-grade J-sign. Patients were further divided into 'jumping' and 'gliding' subgroups based on whether the patella exhibited a 'jumping' sign during flexion-extension motion. All patients received bilateral standard hip-knee-ankle CT scans. The rotational and bony structural parameters of affected knees were measured, and the differences in these variables among the groups were described and analyzed. Reliability analysis was performed to test the consistency of J-sign grading and measurements. There were 92, 100 and 87 patients in the low-, moderate- and high-grade J-sign, respectively. The overall incidence of the jumping sign is 37%. The incidence of the 'Jumping sign' in the high-grade J-sign was significantly higher than in the other two groups (82% vs. 32% vs. 0, p < 0.001). Compared to those with the gliding sign, patients with the jumping sign have higher proportions of increased femoral anteversion (40.8% vs. 24.4%, p = 0.004), excessive knee torsion (61.2% vs. 15.3%, p < 0.001), trochlear dysplasia (95.1% vs. 69.3%, p < 0.001), pronounced supratrochlear spur (73.1% vs. 32.3%, p < 0.001), increased tibial tuberosity-trochlear groove distance (68% vs. 43.3%, p < 0.001), flatter lateral trochlear inclination (81.3% vs. 27.5%, p < 0.001) and excessive sulcus angle (68.7% vs. 35.3%, p = 0.003). No significant morphological differences were found in various bony structural parameters between knees with jumping sign and high-grade J-sign (all p > 0.05). The inter-observer reliability kappa values were 0.65 for the quadrant classification and 0.83 for the new patellar sign. In RPD patients, the rotational and bony structural abnormalities in the jumping sign are highly consistent with the high-grade J sign. This finding may assist the surgeon and their patients in making informed decisions about further imaging tests and osteotomy procedures in the treatment of RPD. Level IV, cross-sectional study.

Transoral C2 osteotomy for treatment of severe irreducible atlantoaxial dislocation after odontoid fracture: about 3 cases.

To report the outcomes of transoral C2 osteotomy (or partial odontoidectomy) and posterior fixation, regarding efficacy and safety, in patients with severe irreducible atlantoaxial dislocation (IAAD) following odontoid fracture. Transoral C2 osteotomy, soft tissue resection, with or without facet joint release, followed by posterior fixation were performed on 3 patients (2012, 2016, 2023) who were suffering from severe IAAD after an odontoid fracture with spinal cord compression. The radiological and clinical outcomes were then assessed. All 3 patients had satisfactory release of their spinal cord compression and good reduction of their IAAD. No neurological or vascular complications were reported. No instrumentation failure, radiolucent zone formation around the screws, infection, or recurrence of dislocation were encountered neither. Bony fusion was successfully achieved in every patient. Transoral C2 osteotomy (or partial odontoidectomy), soft tissue resection, with or without facet joint release, followed by posterior fixation is an effective and reliable method to treat severe IAAD after odontoid fractures.

Anterior Dislocation of Shoulder and Glenoid Version and Inclination; A Cross-Sectional Study

Background: The labrum plays a crucial role in maintaining the stability of the glenohumeral joint. Anterior displacement of the humerus often results in damage to the anterior labrum, causing various lesions. This injury compromises the labrum's stabilizing mechanism, predisposing the shoulder to recurrent dislocations. Objectives: The objective of this study was to use MRI to measure the angles between the glenoid and the humerus, employing the techniques described by Friedman et al. and Poon and Ting (PT). Additionally, the findings were compared between two glenoid groups. Methods: A retrospective comparative cross-sectional study was conducted on patients aged 18 to 70 years with anterior labrum injuries and a control group (individuals without such injuries). These participants underwent MRI imaging of the shoulder using a standard protocol for reasons unrelated to labrum injuries. Results: The study included 55 patients with anterior labrum injuries and 55 individuals from the control group. In the anterior labrum injury group, there were 17 women and 38 men, whereas the control group consisted of 18 women and 37 men. The case group showed a significantly higher rate of anteversion compared to the control group, which was statistically significant (P &lt; 0.001). Conclusions: The degree of caudal inclination was significantly greater in the anterior labrum injury group compared to the control group. Furthermore, it was determined that a higher degree of caudal inclination increases the likelihood of anterior labrum injury by a factor of 3.35, a statistically significant finding.

Risk Factors For Increased External Rotation Deficit After Combined Bankart Repair And Remplissage For Recurrent Anterior Shoulder Instability.

External rotation (ER) deficit following Bankart repair and remplissage (BRR) is reported to be a major concern. The purpose of this study was to identify potential risk factors which correlate with increased postoperative ER deficit in a population which underwent BRR for recurrent anterior shoulder instability and glenoid bone loss (<20%). A retrospective analysis of prospectively collected data was performed on 41 patients who underwent BRR for anterior shoulder instability with glenoid bone loss of < 20%. Inclusion criteria were; a minimum of 2-year postoperative follow-up with available pre and postoperative functional scores (ASES and WOSI) and preoperative MRI. Regression analysis was conducted to detect risk factors for postoperative ER deficit, including age, sex, number of dislocations, length of follow-up, Hill-Sachs interval (HSI), Hill-Sachs depth (HSD), sport participation, number of anchors used for remplissage and hand dominance. A sub-analysis was undertaken after dividing patients into 2 groups (deficit < 20% and ≥ 20%). Correlation between postoperative scores and ER deficit was performed. All patients showed marked improvement in postoperative WOSI and ASES compared to preoperative by a mean difference of 46.2 ± 19.9 and 29.6 ± 14.4 respectively. Compared to the opposite side the mean reduction in external rotation at the side (ERs), external rotation in abduction (ERa), forward flexion (FF) and internal rotations in abduction (IRa) were (21.9% ± 15.5), (14.3% ± 9.9), (2.7% ± 1.9) and (10% ± 6.2) respectively. Univariate regression analysis showed that shorter postoperative time, Larger HSI and the use of two anchors were significantly associated with increased limitation of both ERs and ERa. Participation in sports was significantly associated with less ERs limitation. HSD was significantly associated with increased ERa limitation. Multivariate regression analysis revealed that larger HSI was significantly associated with increased both ERs and ERa limitation. Time of final follow-up and number of anchors were significantly associated with ERs and Era limitation respectively. ≥ 20% ER deficit was significantly associated with lower number of preoperative dislocations, shorter time of final follow-up, HSI, and 2 anchors used in remplissage. No correlation exist between functional scores and ER deficit. There were no recurrent dislocations. The results show that postoperative ER deficit improves over time. Risk factors for increased postoperative ER deficit are larger HSI and when more than one anchor is used for capsulotenodesis. There was no correlation between functional scores and ER deficit.

Recurrent anterior dislocation of radial head treated with ulnar distraction osteotomy and reconstruction of annular ligament using palmaris longus tendon with bioabsorbable screw anchoring: A case report

Introduction: Radial head dislocation in children may be either congenital, an isolated injury or more commonly part of a complex injury to the elbow. Isolated traumatic radial head dislocation in children is a rare and easily missed condition.The reported case shows various treatment and intervention with ulnar osteotomy and annular ligament reconstruction in order to reach the definitive reduction of recurrent dislocation of radial head. Case Presentation: Male 9 years old with anterior dislocation of the radial head, came with difficulty on flexing his elbow due to bony prominence on his anterior elbow. He had recurrent radial head dislocation with redundant annular ligament. From the physical examination there was a prominent radial head on anterior region of elbow. From x-ray examination we found anterior dislocation of ulnar head without any fracture or deformity of ulna. Patient underwent ulnar distraction osteotomy to achieve radial traction and allow stable reduction of radial head. After 5 months he had reconstruction of annular ligament with palmaris longus tendon graft and anchoring with bioabsorbable screw in order to reduce and stabilize the radial head. Conclusion: In this case we found ulnar osteotomy may gave improvement for the reduction of the radial head. But additional annular ligament reconstruction give stability of the radial head which will held in place with full range of motion of the elbow. So this combined procedures hopefully can gave best achievement and satisfactory results of the children and last a lifetime.

Comparison of Anteroposterior Vs. Axial X-rays for Assessing Bone Loss in Recurrent Shoulder Dislocation

Background: Recurrent shoulder dislocation frequently causes the glenoid and humeral head to gradually lose bone, which decreases joint stability and raises the risk of another dislocation. Treating bone loss accurately is crucial, especially when it comes to surgical procedures. The diagnostic precision of axial and anteroposterior (AP) X-rays in identifying and measuring bone loss in patients with repeated shoulder dislocations was examined in this study. Methods: 30 individuals who experienced recurrent shoulder dislocations had axial and anteroposterior (AP) radiography. The humeral head bone loss was measured in millimeters, whereas the glenoid bone loss was expressed as a percentage of the total glenoid surface area. The images were evaluated by two separate radiologists who determined the images' sensitivity, specificity, and accuracy for both modalities. The Intraclass Correlation Coefficient (ICC) was utilized to assess inter-observer reliability, and Receiver Operating Characteristic (ROC) curve analysis was employed to assess overall diagnostic performance. Results: The sensitivity of axial X-rays was found to be much higher (85%) than that of AP X-rays (70%; p &lt; 0.05). Additionally, axial X-rays demonstrated higher accuracy (83% vs.68%) and specificity (80% vs. 65%). Using Axial X-rays, the mean glenoid bone loss was 16.5%, whereas using AP X-rays, it was 14.2%. For axial X-rays, the humeral head bone loss was 5.6 mm, but for AP X-rays, it was 4.8 mm. Compared to AP X-rays, the ICC for inter-observer reliability was greater for axial X-rays (0.88 and 0.85). Axial X-rays performed better diagnostically than AP X-rays (AUC = 0.71), according to ROC analysis. However, Gold standard investigation for bone loss in recurrent sholder dislocation is always a CT scan. Conclusion: When it comes to identifying and measuring bone loss in repeated shoulder dislocations, axial X-rays provide better diagnostic accuracy than AP X-rays, which is why they are the preferred imaging modality for preoperative evaluation.

No secondary osteoarthritis after recession wedge trochleoplasty associated with tibial tubercle osteotomy for treating recurrent patellar dislocation in high-grade dysplasia.

To determine in the long-term the rate of osteoarthritis of recession wedge trochleoplasty performed in patients with high-grade trochlear dysplasia and recurrent patellar dislocations. The hypothesis was that the rate of secondary osteoarthritis was low. Fifteen consecutive patients (17 knees) undergoing a recession wedge trochleoplasty surgery for recurrent patellar dislocation were retrospectively included. Recurrence of dislocation and functional scores of Lille and Kujala were collected. A complete radiological assessment was carried out to assess secondary patella-femoral and femoro-tibial osteoarthritis. No recurrence of dislocation was observed. Mean Lille and Kujala scores were respectively 84 ± 9/100 and 78 ± 12/100 at an average follow-up of 11.2 ± 1.8 years (132 ± 22 months, range 96-165). No significant radiological changes in osteoarthritis were observed. Of the 15 knees without any radiological signs of patellofemoral osteoarthritis at time of surgery, 7 presented a bone remodeling (Iwano1) and 8 had no signs of osteoarthritis at the latest follow-up. Among the 2 knees with a preoperative Iwano stage 1, one evolved to Iwano stage 2. Recession wedge trochleoplasty is an effective treatment for recurrent patellar instability in patients with a high-grade trochlear dysplasia. In the long term, the patellofemoral joint is stable, the functional scores are good, and there is no significant arthritic degeneration. IV, retrospective series.

Lateral Opening Distal Femoral Osteotomy with Concomitant MPFL Reconstruction is Efficacious in Addressing Patellar Instability.

To describe the clinical and radiographic outcomes of patients undergoing a lateral opening distal femur osteotomy (DFO) to address valgus alignment and restore patellar stability. A retrospective review of patients who underwent lateral opening DFO for recurrent patellar instability in the setting of valgus leg alignment at a single academic institution between January 2016 to December 2021 was performed. Patients without a minimum 24-month postoperative follow-up were excluded. Rates of recurrent patellar instability, patient-reported outcomes, and complications were assessed. Pre- and post-operative radiographic anatomic lateral distal femoral angle (aLDFA) was evaluated to assess alignment correction. 20 lateral opening DFO cases were included from 15 patients [mean age 19.6 years, mean follow-up 42.4 months (range 24-63 months)]. 19 of 20 (95.0%) knees experienced no recurrent patellar dislocation. 13 of 20 (65.0%) knees underwent re-operation [hardware removal (n = 10); revision stabilization procedure (n = 1); lysis of adhesions and manipulation under anesthesia (LOA/MUA) (n = 1); nonunion revision with bone grafting (n = 1). mLDFA significantly changed from 86.3 degrees preoperatively to 91.4 degrees postoperatively (p < 0.001). Mean aLDFA changed significantly from 77.4 preoperatively to 84.4 degrees postoperatively (p < 0.001). The final Kujala score had a median value of 92 (IQR 85.5 - 98), Lysholm score was 90 (IQR 76 - 95), and Tegner score was 5 (IQR 4 - 7). Lateral opening DFO is an efficacious procedure to address recurrent patellar instability in patients with valgus leg alignment. The present retrospective case series demonstrates good functional outcomes and low rates of recurrent instability and major complications after a lateral opening DFO, despite a large proportion of patients having undergone previous surgery. There were relatively high rates of reoperation and hardware irritation. Retrospective case series; Level of evidence, 4.

Evaluating the Association Between Vastus Medialis Oblique Characteristics and Patellar Instability: A Comprehensive Case-Control Study.

The contribution of vastus medialis oblique muscle (VMO) weakness or dysfunction to patellofemoral pain syndrome is well recognized, yet its role in lateral patellar instability and recurrent patellar dislocations remains unclear. This study investigates the association between VMO characteristics and patellar instability. Altered VMO structure, characterized by differences in muscle elevation and cross-sectional area (CSA), is associated with patellar instability. A case-control study. Level 3. The study included 204 participants, matched on a 1:1 ratio by age and sex, from a local hospital registry from 2005 to 2020. VMO measurements were taken via magnetic resonance imaging, and included muscle elevation, CSA, fiber angulation, and CSA-to-thigh circumference ratio. Univariate analysis, and multivariable regression model with adjustment for potential confounders were constructed. In addition, a secondary analysis was performed to evaluate the variations in VMO characteristics and mass across primary and recurrent patellar instability groups. Patients with patellar instability demonstrated significant differences in VMO characteristics compared with controls, including increased muscle elevation (13 mm vs 5.9 mm; P < 0.01), increased muscle fiber angulation (42.5° vs 35.3°; P < 0.01), reduced CSA (716 mm2 vs 902 mm2; P < 0.01), and a lower CSA-to-thigh circumference ratio (0.05 vs 0.07; P < 0.01). These findings remained significant in the multivariable adjusted model. Moreover, the secondary analysis revealed that both primary and recurrent instability patients had similar VMO characteristics alterations compared with controls, with slightly more pronounced reductions in VMO CSA in those sustaining recurrent instability episodes. This study confirms a statistically significant association between altered VMO characteristics and patellar instability, emphasizing the importance of considering VMO characteristics in the evaluation and management of patients with patellar instability.

Arthroscopic Eden-Hybinette procedure with Triple-Pulley and four point anti-rotation fixation technique for recurrent anterior dislocation of shoulder joint

To explore effectiveness of arthroscopic Eden-Hybinette procedure with Triple-Pulley and four point anti-rotation fixation technique in the treatment of recurrent anterior dislocation of shoulder joint. A clinical data of 14 patients with recurrent anterior dislocation of shoulder joint and glenoid bone defect, who were met the selective criteria and admitted between February 2021 and February 2022, was retrospectively analyzed. All patients were treated with arthroscopic Eden-Hybinette procedure and the bone blocks were fixed by using Triple-Pulley and four point anti-rotation fixation technique. There were 9 males and 5 females with an average age of 31.2 years (range, 22-40 years). Shoulder dislocation occurred 4-10 times (mean, 6.8 times). The time from the initial dislocation to the admission was 1-6 years (mean, 3.3 years). The Instability Severity Index Score (ISIS) was 7.2±0.8, the Beighton score was 2.9±2.4, and the width ratio of glenoid bone defect was 26.64%±1.86%. Pre- and post-operative visual analogue scale (VAS) score, the University of Califonia-Los Angeles (UCLA) shoulder score, Constant score, and American Association of Shoulder and Elbow Surgeons (ASES) score were used to evaluate shoulder pain and function. The position, healing, resorption, and remodeling (glenoid area) of the bone blocks were evaluated by CT of shoulder joint. All patients underwent surgery successfully without any serious complications. All patients were followed up 11.5-13.8 months (mean, 12.0 months). The VAS scores of shoulder joint after operation decreased compared to preoperative levels, while the UCLA score, Constant score, and ASES score all increased, with significant differences ( P<0.05). And with the prolongation of time, the above indicators further improved, and the differences between different time points were significant ( P<0.05). Imaging reexamination showed that the bone block completely filled the glenoid defect, with good position and no significant displacement. Over time, the bone block healed and partially absorbed and remodelled. The postoperative glenoid area increased significantly compared to preoperative area ( P<0.05). With the prolongation of time, the glenoid area significantly decreased, but the difference was not significant between different time points ( P>0.05). For the recurrent anterior dislocation of shoulder joint, Triple-Pulley and four point anti-rotation fixation technique in Eden-Hybinette procedure can effectively prevent bone rotation, make fixation more reliable, and easy to operate and achieve good effectiveness.

Modified McLaughlin Procedure on Locked Posterior Shoulder Dislocation: A Case Report

Posterior shoulder dislocation is a rare and often misdiagnosed case, and returning the stability of the shoulder and preventing recurrent dislocations are key in improving patient’s quality of life. A 67-year-old male presented with pain, stiffness, and deformity in his right shoulder for the past month. Shoulder and upper arm were in adduction and internal rotation, and abnormal mass of the humeral head was palpated on the posterior shoulder. Shoulder range of motion was severely limited. Modified McLaughlin procedure was performed, followed by immobilization for 2 weeks after surgery. The patient’s mid-term outcome following the modified McLaughlin procedure showed normal shoulder function, with no pain or limitations. This result is likely due to the more stable bony fixation achieved through bone-to-bone union provided by the modified McLaughlin procedure. There were no signs of nerve injury, and no avascular necrosis was observed on the shoulder radiograph.

Assessing Femoral Anteversion in Patients With Bilateral Recurrent Patellar Dislocations.

After first-time lateral patellar dislocation, 44% to 70% of patients sustain redislocations. Increased femoral anteversion (FA) is considered to result in increased lateralizing forces on the patella, which might predispose one to patellar instability. When recurrent patellar dislocations (RPDs) are bilateral, it is unclear if the FA is even more increased. Patients with bilateral RPD would have greater FA than patients with unilateral RPD. Case-control study; Level of evidence, 3. A total of 52 skeletally mature patients with RPD and a clinical suspicion of rotational malalignment underwent rotational computed tomography or magnetic resonance imaging. The uni- or bilaterality of the RPD was determined. A control group comprising 54 adult patients with trauma underwent computed tomography of both lower extremities as part of a multitrauma protocol. The FA values of both lower extremities were evaluated separately. In total, 20 of 52 (38.5%) patients in the study group had a history of unilateral RPD and 32 of 52 (61.5%) patients had a bilateral RPD diagnosis. The mean FA of the asymptomatic limb in unilaterally symptomatic patients was 18.0° (SD, 11.2°; range, 0.5°-40.0°; median, 16.5°). In the symptomatic limb, the mean FA was 19.2° (SD, 9.1°; range, 2.0°-33.0°; median, 19.0°) (mean difference, 1.2°; 95% CI -1.3° to 3.8°). In bilaterally symptomatic patients, the mean FA on the right side was 23.2°, and 22.5° on the left. The mean differences between the symptomatic limbs in the unilateral RPD group and the right or left limbs in the bilateral RPD group were 4.0° (P = .263) and 3.3° (P = .326), respectively. In the control group without RPD, the mean FA was 12.5° (SD, 8.5°; range, 0.8°-33.0°; median, 10.9°). The mean difference between right limbs of the patients with bilateral RPD and right limbs of controls was 10.8° (P = .001). Patients with bilateral RPD have bilaterally greater FA than patients without a history of RPD. Patients with unilateral RPD have greater FA on both sides compared with the control group without a history of lateral patellar dislocation. No statistically significant difference of FA can be seen between patients with bilateral or unilateral RPD.